Large variations in paediatric intensive care unit (PICU) nursing and medical practices in traumatic brain injury (TBI) continue to exist in the UK.1 ,2 This is largely the result of limited paediatric evidence to support therapeutic strategies and the often automatic translation of adult practice into children, without question. Small children are not just “little adults”, however, they vary in their mechanism of injury, response to injury and recovery from brain injury.3

This lecture will present a recent audit showing the variations in UK PICU practices and relate this to previous studies; it will also highlight the differences between children and adults in their response to TBI to highlight why adult evidence may not always translate into paediatrics. In addition, it will provide new evidence for the physiological effects of intensive care nursing interventions in children. Finally, recommendations for practice will be highlighted.